Rational-Emotive Psychotherapy

Albert Ellis, Ph.D.

Rational-emotive therapy—often called RET for short—has many important similarities and differences with various other types of counseling and psychotherapy. Let me, following the excellent outline provided by Dr. Daniel Brown, briefly indicate some of these agreements and disagreements.

First, as to the conception of neurosis in general and neurotic symptoms in particular. Most schools of therapy hold that neurosis arises in the course of people's early child hood, largely because they are taught that certain forms of behavior—such as lusting after their mother, hating others, or failing to be a perfect little man or good little girl—are wrong and blameworthy; because they then consciously or unconsciously begin to hate themselves for performing these "wrong" acts; because they have to exclude from consciousness, or repress, their "wrong" wishes or deeds; because they then tend to construct defenses, such as rationalizations and projections, which prevent them from acknowledging their shameful wrongdoing; and because their defenses ultimately break down at some point, and they are then overwhelmed with anxiety and/or hostility which disrupt their lives and render them constantly upset and ineffective.

Rational-emotive therapy agrees that virtually all neurosis is caused by people's learning to severely blame themselves and/or others and that they will tend to develop neurotic symptoms or defenses against these symptoms unless they can consciously acknowledge that they are severe blamers and unless they can learn how to accept themselves and others even when they commit mistakes and wrongs. RET, however, stresses several causative factors in neurosis which most other therapeutic schools do not stress:

1. It doubts very much whether all neurotic tendencies are learned, but believes instead that significant aspects of them are inborn in the human being. Thus, the rational therapist feels that it is exceptionally easy for humans to learn to excoriate themselves or others because it is their biological nature, especially when they are children, to confuse mistake-making with blaming or sin; and RETers believe that it is very difficult for people who are raised in any kind of society not to excoriate themselves and others when they perpetrate—as they inevitably will perpetrate—misdeeds. The practitioner of RET, in other words, believes that irrational thinking and behaving, or neurosis, is a biological tendency and that all of us are more or less afflicted by it. It may well be, and almost always is, seriously exacerbated by social learning in general and by parental upbringing in particular; but it is essentially and deeply rooted in the mere state of being human and living with other people.

2. While RET accepts the fact that neurotic states are often originally learned or aggravated by early inculcation of irrational beliefs or by propagandization by significant others, it says that these early-acquired irrationalities are not automatically sustained over the years by mere lack of counter- propagandization, but that they instead are very actively and creatively reinstilled or resuggested by people themselves. And it is largely people's repeating to themselves early-acquired neurotic beliefs, rather than their parents' or others' repetition to them, that sustains and eternally perpetuates their neurosis.

3. RET theory holds that emotions rarely have an independent existence in themselves, but are closely allied to and are the products of human thinking. We think something is bad, and we feel badly in connection with it; or we think something is good, and we feel delighted about it. Most everyday human thoughts, moreover, are not held symbolically, pictorially, or non-verbally but are quite verbally represented in the individual's cognitive processes. Most emotions, in other words, follow from simple exclamatory sentences or meanings which people (consciously or unconsciously) tell or signal themselves immediately prior to experiencing these emotions. Neurosis, therefore, essentially consists of mistaken, illogical, unvalidateable sentences or meanings in which neurotics dogmatically and unchallengingly believe, and upon which they therefore emote or act to their own defeat.

4. RET theory, while stating that tendencies toward irrational self-verbalizations are inborn in all normal humans, and while agreeing that many such self-defeating internal verbalizations are learned during early childhood, also insists that neurotic behavior can be acquired at anytime in people's lives, particularly during adolescent years, even if they have had an ideal early upbringing.

In regard to major objectives of psychotherapy, RET agrees with the Freudians, neo- Freudians, client-centered therapists, and most other therapists that probably the most important goal is to help clients to stop blaming themselves and others, and to accept themselves in spite of their inherent limitations, mistakes, and wrongdoings. It is probably more specific in this regard than any other school of therapy, since it actively and directly teaches patients that no one is ever damnable for anything, and that healthy people can definitely accept and like themselves whether or not they are successful in life and whether or not anyone else in the world loves them.

In reference to major objectives of therapy, RET has several main differences with several other schools:

1. It insists that people, while being quite assertive or self-expressive, can definitely change and conquer, rather than merely express or sublimate, their basic hostility. It holds that hostility invariably arises from (a) the sane sentence "I don't like your behavior" and (b) the insane sentence, "Because I don't like your behavior, you absolutely should not or ought not display it." The RET practitioner attempts to help to dispel their hostility by changing their client's absolutistic, grandiose sentence to: "Because I don't like your behavior, I am going to try to calmly induce you to change it. If I succeed, fine. If I don't, that'[s too damned bad; but I can still live successfully in a world where many people's behavior is too damned bad."

2. The rational therapist holds that human adults do not need to be accepted or loved, even though it is highly desirable that they be. He or she therefore teaches clients how to feel unhurt and un-self-castigating even they are unaccepted and loved by people who are significant to them. RET encourages clients to be appropriately sad or regretful when they are rejected, or frustrated or irritated when they are deprived; but it tries to teach them how to overcome all deep-seated manifestations of hurt, self- depreciation, and depression.

3. Because of its holding that human emotional disturbance is essentially ideologically or philosophically based, RET strives for a thoroughgoing philosophic reorientation of a person's outlook on life, rather than for a mere removal of any of his mental or psychosomatic symptoms. It tries to help clients minimize general anxiety rather than reduce some specific phobia and minimize their generalized tendency to hate rather than reduce particular hatred of their mother or mates.

4. Because RET practitioners realistically accept the biological as well as the sociological causes of disturbance, they often try to help people (a) live rationally with their idiosyncratic biological deficiencies and (b) actually overcome some of their inborn handicaps. Just as, with much work and practice, trapeze artists can overcome their innate tendency to walk on the ground rather than fly through the air, so RET holds that many clients—such as those who are organically or psychotically afflicted—can reduce their innate tendencies to think crookedly and behave erratically. RET, unlike some other forms of psychotherapy, does not give up on innately deficient individuals, even though it recognizes that they often can be helped to a lesser degree than the less biologically handicapped.

In regard to selectivity of clients, rational therapists find, along with most other kinds of therapists, that individuals who are intelligent, young, and highly motivated to get better make the most progress and do so in a minimum of time. Where, however, some forms of therapy are contraindicated for certain types of clients—for example, classical psychoanalysis should normally not be used with psychotics or psychopaths—RET seems to harm no type of patient thus far discovered and to be effective, although to a different degree, with virtually all types of disturbed individuals. Normal children and dull normal adults can achieve considerable benefits from it; and so can psychopaths and psychotics. Its techniques are largely so direct and simple that even the most highly confused and uneducated clients can usually get something out of it.

The type of client with whom rational- emotive psychotherapy gets the poorest results is unmotivated or goofing individuals, whose symptom of avoiding and evading the difficulties and hard work of life itself also apply to their half-hearted attempts to working at therapy. Such clients can often be shown, in the course of RET sessions, that they will keep defeating themselves if they persist in their goofing and that there is no magic way, by therapy or any other means, in which they can be helped without their buckling down to help themselves. But in many instances they refuse to be shown this, and they end therapy with little or no gains. I have also found from my past experience with psychoanalytic and other therapeutic techniques that practically all forms of psychotherapy produce poor results with this type of individual. The technique of group rational-emotive therapy has sometimes been found effective with goofing and unmotivated patients when individual sessions become unproductive.

In regard to the relative emphasis it places on the past versus the present life experiences of the individual, RET is quite similar to the Horney, client-centered, and existentialist schools, which emphasize people's experiences in the here and now and their present ability to change early-acquired thinking and emoting patterns of behavior. It does not, like the Sullivanian school, overemphasize clients' present experiences with the therapist, and endlessly show them how these are connected with their past, although it does some of this sort of thing. It mainly stresses that no matter what clients' basic irrational philosophy of life is, nor when and how they acquired it, they are presently sick because they still believe this self-defeating world- and self-view. And it says that right now, if people will observe exactly what they are telling or signalling themselves, and will challenge and question their present self-verbalizations, they will usually get better, even if they never find the exact early origin of their neurosis. In this respect, RET is radically different from the classical Freudian and most of the neo- Freudian schools (including even the Adler ian group) which spend much time digging up clients' early history and making significant connections between the history and their present behavior. It also differs significantly from the Meyerian psychobiologic and the casework school of therapy, which encourage a case history approach. In many RET cases the therapist learns very little about clients' parents or family upbringing; and yet helps to bring about significant and permanent changes in their disturbed patterns of living.

In regard to specific techniques or adjuncts utilized in the course of therapy, RET is closed to the eclectic school and the Adlerian and neo-Freudian schools, since it employs a wide variety of therapeutic techniques—even including, at times, what it considers to be the relatively inefficient methods of free association and dream analysis. And, on the other end of the scale, it also sanctions the use of such direct techniques as hypnotherapy and the deconditioning processes of Wolpe and the learning theory therapists. There are several respects, however, in which RET is rather unique in regard to technique:

1. It is probably the only method which tries to show clients that they are usually telling themselves concrete, simple exclamatory sentences to create their disordered emotions and their ineffectual behavior, and that teaches them how to observe, to logically parse, to challenge, and to contradict these disturbance-creating sentences.

2. It is one of the most activity-directive of all therapeutic methods, since it holds that patients must not only gain insight into what nonsense they are consciously and unconsciously telling themselves, but that they must both think and act in counter- propagandizing ways. In RET, therefore, actual homework assignments are frequently given to individual and group therapy clients: assignments such as dating a woman whom the client is afraid to ask for a date; looking for a new job; experimentally returning to live with a husband with whom one has previously continually quarreled; etc. The therapist quite actively tries to persuade, cajole, and at times even urge the client to undertake such assignments as an integral part of the therapeutic process.

3. In RET the therapists are unusually active during the therapeutic sessions, in that they do a great deal of talking rather than passively listening to what the client has to say; they do not hesitate, even during the first session, directly to confront the clients with evidences of their irrational thinking and behaving; they very actively interpret, without worrying too much about possible resistances and defenses on the part of the client; they consistently try to persuade and argue clients out of their firmly held irrational and inconsistent beliefs; and they unhesitatingly attack clients' neurosis- creating ideas and attitudes after first demonstrating how and why they exist. As I note in my book, Reason and Emotion in Psychotherapy (Ellis, 1962), "to the usual psychotherapeutic techniques of exploration, excavation, and interpretation, the rational therapist adds the more direct techniques of confrontation, confutation, deindoctrination, and reeducation. He thereby frankly faces and resolutely tackles the most deep-seated and recalcitrant patterns of emotional disturbance."

In regard to relative emphasis on interpretation and insight, rational-emotive psycho therapy agrees with most Freudian, neo- Freudian, Adlerian, and Jungian schools in that it holds that clients acquiring insight, especially so-called emotional insight, into the source of their disturbances is a most important, and usually essential, part of their treatment. It therefore, like these other schools, stresses interpretation as a therapeutic tool.

RET, however, distinguishes sharply between so-called intellectual and so-called emotional insight, and operationally defines intellectual insight as clients' knowing or seeing the cause of their problems and working, in a determined and energetic manner, to apply this knowledge to the solution of these problems.

RET also distinguishes three different levels of insight. Insight No. 1 is clients seeing that their present neurotic behavior has antecedent causes. This is the kind of insight stressed by most psychoanalytic and other forms of therapy. Insight No. 2 is their acknowledging that the reason why the original causes of their disturbance still upset and disorganize them is because they themselves still believe in, and endlessly keep repeating to themselves, the irrational beliefs that they previously acquired. Insight No. 3 is the clients acknowledging that there is no other way for them to get better but their continually observing, questioning, and challenging their own belief-systems, and their working and practicing, to change their own irrational beliefs by verbal and motor counter-propagandizing activity. RET therefore puts relatively little stress on Insight No. 1, clients seeing the historical antecedents of their present behavior; but it particularly stresses Insights Nos. 2 and 3, their acknowledging that they now keep the original neuroticizing ideas alive and that they, and only they, can rationally-emotively think and work to eliminate them.

In regard to relative emphasis on transference and the relationship in psychotherapy, rational-emotive therapy agrees with most therapists that the relationship between therapist and client plays a significant part in the therapeutic process. But it holds that the most important aspects of transference are not the personal relations between the therapist and his patient, nor the warmth and affection shown by the therapist to the client. Instead, RET stresses the importance of (a) therapists acting as a good model for clients to emulate, by demonstrating in the course of therapy that they themselves are not highly disturbed, that they do not react to the client's hostility with counter-hostility, and they have the guts to face the client's problems frankly and squarely, and to make a direct attack on the client's irrational beliefs, because they are not anxious about whether the client loves them or not, and have no neurotic need for the client's approval. RET stresses (b) the authoritative, scientific help that the client can get from the highly trained, and presumably rational, therapist. It emphasizes (c) the unconditional positive regard that the therapist has for clients in the sense that the therapist never damns clients for even their worst errors or most heinous crimes, but continues to accept them as an essentially worthwhile human being just because they, the clients, exist, and not because they accomplish any great things in life or act particularly well.

In actual RET practice, only a small percentage of time is usually spent in analyzing the transference relationship between therapist and client, because this is only one of a variety of techniques that the therapist may employ to show the clients that they are thinking and behaving irrationally and that they need not continue to do so. Instead of overemphasizing the emotionalized transferences that clients make from outside significant figures in their life (such as their parents) to the therapist, RET tends to stress what Bertram Forer (1961) calls outsight: namely, clients misinterpreting the feelings of others because they are looking anxiously for proof that these others are against them, when they actually are hardly concerned with the clients at all. RET also emphasizes the generalized distorted love needs of clients, rather than their specific demands for the therapist's love and attention, which are utilized mainly as a specific illustration of their generalized dire needs for love. An entire series of highly successful RET therapy sessions may therefore be concluded without any creation or analysis of the transference neurosis between client and therapist and without any occurrence of a highly personalized relationship between the two. Where typical transference phenomena arise in the course of RET—as they sometimes do—they are usually directly interpreted and resolved. But it is surprising how often such typical transference reactions do not occur in the course of rational- emotive therapy.

The essential basis for improvement or change in the people in the course of RET is considered to be not the removal of their presenting symptoms but a significant, deep- seated, and lasting change in their basic philosophy of life; especially in their view that anxiety and hostility are necessary correlates of living. Like most other forms of psychotherapy, RET agrees that people who experience intense, prolonged, or repeated feelings of anxiety and/or hostility are emotionally disturbed; and that basic change occurs in such people when they no longer experience such intense, prolonged, or repeated feelings—even though at times they continue to experience reality-based fear (for example, when a car is hurtling directly at them) or rationally-based frustra tion, annoyance, or deprivation (for example, when they actually suffer the loss of a beloved individual).

Unlike most systems of therapy, which seem to believe that there is some single, all- important requisite for basic personality change, RET holds that there is probably not such a single, necessary and sufficient condition or set of conditions. Thus, the client-centered therapists seem to believe with Rogers (1957) that clients to be truly changed in basic personality structure must experience the therapist's unconditional positive regard: the Freudians (Freud, 1924-1950) contend that they must undergo and resolve a transference neurosis during therapy; and the Reichians (Reich, 1949) insist that clients must have their character armor attacked and unloosened by the therapist before they can make real move ment in treatment. RET practitioners, on the contrary, believe that people somehow come up against significant life experiences, or learn from their reading about others' experiences, or sit down and think for themselves, or enter a relationship with a therapist, or otherwise decide to work at changing themselves in order to make significant and lasting personality changes. Rational-emotive therapists consequently believe that RET is not the only effective method of therapy, but simply that it is one of the most effective techniques that has so far been invented.

In regard to the duration of psychotherapy, RET agrees with most other therapeutic schools that it takes some amount of time for people to change their basic personality structure, and that therefore the total period of therapy should preferably last from two to three years. Unlike most psychoanalytic therapies, however, RET encourages clients to come for therapy once a week or less, and to focus during the last years or months on group rather than individual therapy sessions. In my own practice, clients who actually come for a total period of, say, two years, will have had probably about 30 individual and 50 group sessions—which is considerably less hours than my first clients, whom I treated with classical psychoanalysis or psychoanalytically-oriented psycho therapy, had. But my results with the use of RET are significantly better than my results used to be with psychoanalytic therapy (Ellis, 1957).

As regards the permanence of improvement of patients, I find that RET resembles other methods of psychotherapy that I have em ployed in the past in that many clients who feel fine at the end of the therapeutic process later gradually slip back to their own irrational ways of thinking and behaving, especially as they are repropagandizes by the people with whom they intimately associate; and consequently some of them have to return for further therapy. I think that if accurate follow-up studies of clients were done, this would be true of those successfully concluding all kinds of therapy.

With the use of RET, however, I have found that a smaller percentage of clients return than when I formerly practiced psy choanalytic therapy; that those who return usually only need a few "refresher" sessions; and that serious setbacks of initially successful clients are rare. I also find that many clients who originally gain help during RET sessions are later, when they are on their own, able to keep helping and changing themselves in accordance with the principles of rational thinking they have learned during therapy, and that these clients improve over the years.

RET, as mentioned above, rarely aims just at symptom removal but instead almost invariably strives for a basic reorientation in the client's philosophy of living. It is found that when symptoms are removed without such a basic personality change taking place, they are not necessarily replaced by substitute symptoms, but rather by other symptomatic manifestations of the client's still-held fundamental irrational beliefs. Thus, if a male believes that he must be accepted and approved by others or he is worthless, and he consequently is afraid to risk speaking in public and making a fool of himself, helping him get over his fear of public speaking may do him a lot of good, and will not necessarily lead to substitute symptoms, such as fear of swimming or of riding on trains. But if he still basically believes that he must be accepted by others, it will be virtually impossible for him not to have other symptomatic manifestations of this belief: such as fear of approaching women at dances, or proposing to a woman he dearly loves, or asking his boss for a raise. RET practitioners, therefore, do not find symptom removal a poor or useless form of therapy, but do find it to be a highly limited advance that usually still leaves clients with their basic neurosis. That is why although they in theory do not oppose the work of Wolpe and the other deconditioning therapists, in practice they do not just employ this limited mode of treatment.

SUMMARY

Rational-emotive therapy overlaps in many significant respects various other schools of therapy. On theoretical grounds, it has much in common with the Adlerians, the ego psychologists, the psychobiologists, the general semanticists, the directive therapists, the learning theorists, and the existentialists. In regard to effecting basic personality change in the client, its goals and ideals are somewhat similar to those of many groups, such as the client-centered, existentialist, and neo-Freudian schools. Its main practices, however, are radically different from those of most other therapies in that it emphasizes rapid and forceful confrontation, a direct approach to clients' unconscious thinking or unverbalized attitudes, vigorous attacks on their irrational and inconsistent philosophies, homework assignments, spurs to their outside activity, energetic didactic reeducation, and many other active-directive techniques which are highly antithetical to the methods employed by most therapists. Its practices, moreover, are not merely eclectically derived, but are based on theo retical constructs that supplement, and in some respects contradict, those of most other therapeutic schools. In consequence, RET seems to be a distinct and new school of therapeutic theory and practice that merits its own independent standing among the ever- growing variety of psychotherapy approaches.

REFERENCES

Ellis, A. Outcome of employing three techniques of psychotherapy. J. Clin. Psychol., 1957, 13, 334-350.

Ellis, A. Reason and emotion in psycho therapy. Secaucus, NJ: Citadel, 1962.

Forer, B. Schizophrenia: The narcissistic retreat. J. Proj. Tech., 1961, 25, 422-430.

Freud, S. Collected papers. London: Imago Publishers, 1924-1950.

Reich, W. Character analysis. New York: Orgone Institute Press, 1949.

Rogers, C.R. The necessary and sufficient conditions of therapeutic personality change. J. Consult. Psychol., 1957, 21, 459-461.